Reconstructive Surgery

TRICARE covers cosmetic, reconstructive, and plastic surgery to improve your physical appearance only under these circumstances:

  • Correction of a birth defect, including cleft lip
  • Restoration of a body form following an accidental injury
  • Revision of disfiguring and extensive scars resulting from neoplastic surgery, like surgery that removes a tumor or cyst
  • Reconstructive breast surgery following a medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. mastectomy
  • Reconstructive breast surgery due to a birth defect
  • Penile implants and testicular prostheses for conditions resulting from organic origins or for organic impotency
  • Surgery to correct pectus excavatum
  • Panniculectomy, or tummy tuck, performed in conjunction with an abdominal or pelvic surgery. This is when a medical review determines that the procedure significantly contributes to the safe and effective correction or improvement of bodily function.
  • Liposuction, when medically necessary. This includes treatment for lipedema when you meet all the conditions below.
    • You have a clinical diagnosis of lipedema stage I, II, or III.
    • You’re 18 years old or older.
    • You have a body mass index of less than 30.
    • You have a documented record of pain and tenderness in affected areas, and the liposuction will significantly contribute to the safe and effective correction or improvement of your bodily function.
    • Your symptoms aren’t responding to at least six consecutive months of treatment.
    • An authorized surgeon trained in liposuction will perform the procedure.
    • You have a pre-authorization.

When must my surgery happen? Your surgery must happen no later than Dec. 31 of the year after your accidental injury or surgical trauma. The exceptions are:

  • Postmastectomy reconstructive breast surgery
  • Cases involving children who may require a growth period

Exclusions

TRICARE doesn’t cover cosmetic, reconstructive, or plastic surgery in the following cases: 

  • Dental congenital anomalies
  • Cosmetic procedures performed mainly for psychological or psychiatric reasons
  • Elective correction of minor skin blemishes and marks
  • Breast augmentation
  • Procedures for personal reasons to improve appearance
  • Facelifts
  • Chemical peeling for aging skin, wrinkles, or acne
  • Hair transplants
  • Tattoo removal

The following procedures are excluded with limited exceptions. Check with your regional contractor for specific coverage details and requirements. 

  • Reduction mammoplasty, or breast reductions
  • Blepharoplasty, or removal of excess skin on the eyelid
  • Rhinoplasty, or nose surgery
  • Otoplasty
  • Revision of scars, except from neoplastic surgery
  • Dermabrasion of the face
  • Electrolysis or laser hair removal
Disclaimer:

This list of covered services is not all inclusive. TRICARE covers services that are medically necessary and considered proven. There are special rules or limits on certain services, and some services are excluded.

Last Updated 10/29/2024